Method for lowering serum glucose

ABSTRACT

A method for treating hyperglycemia and/or reducing serum glucose levels in a patient that includes administering to the patient a therapeutically effective amount of an amine polymer is disclosed. In one embodiment, the amine polymer is aliphatic. Examples of polymers useful in an embodiment of the invention include sevelamer hydrogen chloride and colesevelam. The invention includes the use of amine polymers such as a cross-linked polymer characterized by a repeat unit having the formula:  
                 
and salts and copolymers thereof, where n is a positive integer and x is zero or an integer between 1 and about 4. Also described is a use, for the manufacture of a medicament, of a polymer that lowers serum glucose.

RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.10/125,700, filed Apr. 17, 2002, which claims the benefit of U.S.Provisional Application No. 60/305,564, filed on Jul. 13, 2001, and U.S.Provisional Application No. 60/284,445, filed on Apr. 18, 2001.

The entire teachings of the above applications are incorporated hereinby reference.

BACKGROUND OF THE INVENTION

Nondiabetic hyperglycemia (high blood glucose concentration) is anindicator of cardiovascular risk (Balkan, B. et al., 21 Diabetes Care,360 (1998)). About 16 million Americans have type 2 diabetes.Individuals with both type 2 and type 1 diabetes have elevated bloodsugar levels due to insulin regulation problems. Individuals withdiabetes who practice tight blood glucose control can substantiallyreduce the risk of developing vascular complications of diabetes,including diabetic retinopathy (a condition which leads to blindness),diabetic nephropathy, diabetic neuropathy, and atherosclerosis.

Current methods of controlling blood glucose concentration includeinsulin injections, oral administration of sulfonylureas, glucophage (abiguanide drug), alpha-glucosidase inhibitors, and thiazolidinedione.Some of these therapies have serious side-effects.

SUMMARY OF THE INVENTION

The present invention relates to the discovery that aliphatic aminepolymers, such as sevelamer hydrogen chloride and colesevelam, lowerserum glucose levels upon administration to the gastrointestinal tract.As such, the invention relates to a treatment for high blood glucoselevels with a polymer that binds to glucose, or otherwise lowers serumglucose-levels, such as a polymer that possesses a glucose-levellowering effect as an indirect result upon administration, (i.e., notdependent upon glucose-binding). One embodiment of the inventionincludes a treatment for reducing serum glucose levels in individualswith diabetes; another embodiment includes a treatment for non-diabeticindividuals with hyperglycemia.

The invention includes the use of polymers which bind glucose andprecursors of glucose, preventing its absorption (or reabsorption), orwhich otherwise cause a serum glucose-lowering effect. Functional groupsthat can bind to glucose can be attached to a polymer backbone, thepolymer preferably of sufficient molecular weight to prevent absorption.

In one preferred embodiment the polymer is a cross-linked polyamine. Thecross-linking avoids or minimizes absorption of the polymer in thepatient. Such polyamines can include aliphatic amine polymers such as,polyallylamine, polydiallylamine, polyethyleneimine (linear orbranched), polyvinylamine, polybutenylamine, polylysine, polyarginine,and poly(aminopropylacrylamide). The polyamines can also includearomatic amine polymers such as cholestyramine.

Preferred polymers employed in the invention comprise water-insoluble,non-absorbable, and cross-linked polyamines as described herein. Thepolyamines of the invention can be amine or ammonium-containingaliphatic polymers. An aliphatic amine polymer, is a polymer whichcontains aliphatic amine moieties. In a preferred embodiment, thepolymers are characterized by one or more monomeric units of Formula I:

and salts thereof, where n is a positive integer and x is 0 or aninteger between 1 and about 4, preferably 1. In preferred embodiments,the polymer is cross-linked by means of a multifunctional cross-linkingagent.

The invention provides an effective treatment for reducing high levelsof glucose in the blood. The invention also provides for the use of thepolymers described herein for the manufacture of a medicament for thetreatment of hyperglycemia.

Other features and advantages will be apparent from the followingdescription of the preferred embodiments thereof and from the claims.

DETAILED DESCRIPTION OF THE INVENTION

As described above, the preferred polymers employed in the inventioncomprise water-insoluble, non-absorbable, cross-linked polyamines.Preferred polymers are aliphatic. Examples of preferred polymers includepolyethyleneimine, polyallylamine, polyvinylamine and polydiallylaminepolymers. The polymers can be homopolymers or copolymers, as discussedbelow, and can be substituted or unsubstituted. These and other polymerswhich can be used in the claimed invention have been reported in U.S.Pat. Nos. 5,487,888; 5,496,545; 5,607,669; 5,618,530; 5,624,963;5,667,775; 5,679,717; 5,703,188; 5,702,696 and 5,693,675, the contentsof which are hereby incorporated herein by reference in theirentireties. Polymers suitable for use in the invention are also reportedin copending U.S. application Ser. Nos. 08/659,264; 08/823,699;08/835,857; 08/470,940; 08/826,197; 08/777,408; 08/927,247; 08/964,498;08/964,536 and 09/359,226, the contents of which are incorporated hereinby reference in their entireties.

The polymer can be a homopolymer or a copolymer of one or moreamine-containing monomers or a copolymer of one or more amine-containingmonomers in combination with one or more non-amine containing monomers.Where copolymers are manufactured with the monomer of the above FormulaI, the comonomers are preferably inert and non-toxic. Examples ofsuitable non-amine-containing monomers include vinylalcohol, acrylicacid, acrylamide, and vinylformamide. Examples of amine-containingmonomers preferably include monomers having the Formula I above.Preferably, the monomers are aliphatic. Most preferably, the polymer isa homopolymer, such as a homopolyallylamine, homopolyvinylamine,homopolydiallylamine or polyethylenamine. The term “amine,” as usedherein, includes primary, secondary and tertiary amines, as well asammoniums such as trialkylammonium, and guanidino groups.

Other preferred polymers include polymers characterized by one or morerepeat units set forth below.

or copolymers thereof, wherein n is a positive integer, y and z are bothintegers of one or more (e.g., between about one and about 10) and eachR, R1, R2, and R3, independently, is H, or a substituted orunsubstituted alkyl group (e.g., having between 1 and 25 or between 1and 5 carbon atoms, inclusive), alkylamino, (e.g., having between 1 and5 carbons atoms, inclusive, such as ethylamino or poly(ethylamino)) oraryl (e.g., phenyl) group, and each X— is an exchangeable negativelycharged counterion.

In one preferred polymer, at least one of R, R1, R2, or R3 groups is ahydrogen atom. In a more preferred embodiment, each of these groups arehydrogen.

In each case, the R groups can carry one or more substituents. Suitablesubstituents include therapeutic cationic groups, e.g., quaternaryammonium groups, or amine groups, e.g., primary, secondary or tertiaryalkyl or aryl amines. Examples of other suitable substituents includehydroxy, alkoxy, carboxamide, sulfonamide, halogen, alkyl, aryl,hydrazine, guanidine, urea, poly(alkyleneimine), such aspoly(ethyleneimine), and carboxylic acid esters.

Preferably, the polymer is rendered water-insoluble by cross-linking.The cross-linking agent can be characterized by functional groups whichreact with the amino group of the monomer. Alternatively, thecross-linking group can be characterized by two or more vinyl groupswhich undergo free radical polymerization with the amine monomer.

Examples of suitable cross-linking agents include diacrylates anddimethylacrylates (e.g. ethylene glycol diacrylate, propylene glycoldiacrylate, butylene glycol diacrylate, ethylene glycol dimethacrylate,propylene glycol dimethacrylate, butylene glycol dimethacrylate,polyethyleneglycol dimethacrylate and polyethyleneglycol diacrylate),methylene bisacrylamide, methylene bismethacrylamide, ethylenebisacrylamide, ethylene bismethacrylamide, ethylidene bisacrylamide,divinylbenzene, bisphenol A, dimethacrylate and bisphenol A diacrylate.The cross-linking agent can also include acryloyl chloride,epichlorohydrin, butanediol diglycidyl ether, ethanediol diglycidylether, succinyl dichloride, the diglycidal ether of bisphenol A,pyromellitic dianhydride, toluene diisocyanate, ethylene diamine anddimethyl succinate.

Preferably the polymer is non-absorbable in the gastrointestinal tractand/or substantially water-insoluble. The polymer can be characterizedby 1 or more monomeric units and/or possess a molecular weight of about570 or more, preferably about 5,000 daltons or more.

The terms “insoluble,” “substantially water-insoluble,” and grammaticalvariations thereof, as used herein, refer to a polymer or othersubstance which does not dissolve in an aqueous-based system, or whichdissolves or solubilizes at a slower rate than does a water-solublesubstance. Water-insoluble polymers introduced into the gastrointestinaltract are not absorbed systemically, or are absorbed to a lesser extentthan are water-soluble polymers.

“Nonabsorbent” or “non-absorbable,” as the terms are used herein, meansthat the polymer or other substance so described does not dissolve inthe gastrointestinal tract, or dissolves to a lesser extent than does anabsorbent or absorbable substance, or does not erode, degrade, orotherwise break down in vitro to form smaller chemical species by eitherphysical or chemical processes. Therefore, a non-absorbable polymer isnot absorbed systemically or is absorbed to a lesser extent than is anabsorbable polymer.

A preferred cross-linking agent is epichlorohydrin because of its highavailability and low cost. Epichlorohydrin is also advantageous becauseof its low molecular weight and hydrophilic nature, increasing thewater-swellability and gel properties of the polyamine.

The level of cross-linking makes the polymers insoluble andsubstantially resistant to absorption and degradation, thereby limitingthe activity of the polymer to the gastrointestinal tract, and reducingpotential side-effects in the patient. The compositions thus tend to benon-systemic in activity. Typically, the cross-linking agent is presentin an amount from about 0.5-35% or about 0.5-25% (such as from about2.5-20% or about 1-10%) by weight, based upon total weight of monomerplus cross-linking agent. The polymers can also be further derivatized;examples include alkylated amine polymers, as described, for example, inU.S. Pat. Nos. 5,679,717, 5,607,669 and 5,618,530, the teachings ofwhich are incorporated herein by reference in their entireties.Preferred alkylating agents include hydrophobic groups (such asaliphatic hydrophobic groups) and/or quaternary ammonium- oramine-substituted alkyl groups.

Non-cross-linked and cross-linked polyallylamine and polyvinylamine aregenerally known in the art and are commercially available. Methods forthe manufacture of polyallylamine and polyvinylamine, and cross-linkedderivatives thereof, are described in the above US Patents. Harada etal. (U.S. Pat. Nos. 4,605,701 and 4,528,347), which are incorporatedherein by reference in their entireties, also describe methods ofmanufacturing polyallylamine and cross-linked polyallylamine.

In other embodiments, the polymer can be a homopolymer or copolymer ofpolybutenylamine, polylysine, or polyarginine. Alternatively, thepolymer can be an aromatic polymer, such as an amine orammonium-substituted polystyrene, (e.g., cholestyramine).

As described above the polymer can be administered in the form of asalt. By “salt” it is meant that the nitrogen group in the repeat unitis protonated to create a positively charged nitrogen atom associatedwith a negatively charged counterion. A preferred polymer is a low salt,such as low chloride, form of polyallylamine where less than 40% of theamine groups are protonated.

The cationic counterions can be selected to minimize adverse effects onthe patient, as is more particularly described below. Examples ofsuitable counterions include organic ions, inorganic ions, or acombination thereof, such as halides (Cl— and Br—), CH3OSO3—, HSO4—,SO42—, HCO3—, CO3—, acetate, lactate, succinate, propionate, oxalate,butyrate, ascorbate, citrate, dihydrogen citrate, tartrate,taurocholate, glycocholate, cholate, hydrogen citrate, maleate,benzoate, folate, an amino acid derivative, or a lipid. The counterionscan be the same as, or different from, each other. For example, thepolymer can contain two different types of counterions.

The polymers, according to an embodiment of the invention, areadministered to a patient in a therapeutically effective amount. As usedherein, the terms “therapeutically effective amount” and“therapeutically effective dose” refer to the amount of an active agent,for example, a therapeutically effective substance, such as a polymerdescribed herein, required to be administered in order to induce adesired result in the patient. That result may be alleviation oramelioration (complete or partial) of the symptoms or condition of thepatient in need of treatment, or any other desired improvement in thepatient's symptoms, disease or condition.

As used herein, the term “therapeutically effective amount” may alsorefer to the quantity of active agent or therapeutically effectivesubstance, such as an amine polymer described herein, the administrationof which results in improvement in the patient's symptoms, disease, orcondition, where little or no improvement would occur in the absence ofthe active agent. Typically, the polymer is administered for asufficient period of time to achieve the desired therapeutic effect.

Therapeutic efficacy may be determined by using standard pharmacologicalprocedures in experimental animals.

The polymers according to the invention can be administered to thegastrointestinal tract in a dosage comprising between about 1 ÿg/kg/dayand about 1 g/kg/day. The particular dosage will depend on theindividual patient (e.g., the patient's weight and the extent of glucoseremoval required) and on the nature of the polymer used. Polymersaccording to the invention can be administered in one or several dosesper day. In one embodiment, it is presently contemplated that, fortherapeutic treatments, at least one polymer of the present inventioncan be administered to an adult in an amount comprising between about 70ÿg and about 91 g per day; between about 0.1 g and about 10 g per day;between about 0.5 g and about 6 g per day; or between about 0.5 g andabout 3 g per day. The polymer can be administrated either in hydratedor dehydrated form, and can be flavored or added to a food or drink, ifdesired, to enhance patient acceptability. A preferred adult dose isbetween about 3 g and about 6 g per day. The polymer is preferably givenwith food.

Additional ingredients such as ingredients for treating other relatedindications, or inert ingredients, such as artificial coloring agentscan be added as well.

The additional active ingredients can be administered simultaneously orsequentially with the polymer. Where the ingredients are administeredsimultaneously, they can optionally be bound to the polymer, forexample, by covalent bonding or by physically encapsulating theingredient, on the exterior or interior of the polymeric particle.Covalent bonding can be accomplished by reacting the polymer andingredient(s) with suitable cross-linking agents. For example,polyallylamine and penicillamine can be cross-linked via hydrolyzablebond.

Examples of suitable forms for administration (preferably oraladministration) include pills, tablets, capsules, and powders (e.g., forsprinkling on food or incorporating into a drink). The pill, tablet,capsule, or powder can be coated with a substance capable of protectingthe composition from disintegration in the esophagus but will allowdisintegration as the composition in the stomach and mixing with food topass into the patient's small intestine. The polymer can be administeredalone or in combination with a pharmaceutically acceptable carriersubstance, e.g., zinc salts or magnesium carbonate, with which thepolymer can form a micelle.

The polymers of the invention can be used to treat patients, preferablyhumans, with high glucose levels, or as a prophylactic.

EXEMPLIFICATION A. Polymer Preparation Example 1 Poly(vinylamine)

The first step involved the preparation of ethylidenebisacetamide.Acetamide (118 g), acetaldehyde (44.06 g), glucose acetate (0.2 g), andwater (300 mL) were placed in a 1 L three neck flask fitted withcondenser, thermometer, and mechanically stirred. Concentrated HCl (34mL) was added and the mixture was heated to 45-50° C. with stirring for24 hours. The water was then removed in vacuo to leave a thick sludgewhich formed crystals on cooling to 5° C. Acetone (200 mL) was added andstirred for a few minutes, after which the solid was filtered off anddiscarded. The acetone was cooled to 0° C. and solid was filtered off.The solid was rinsed in 500 mL acetone and air dried 18 hours to yield31.5 g of ethylidenebis-acetamide.

The next step involved the preparation of vinylacetamide fromethylidenebisacetamide. Ethylidenebisacetamide (31.05 g), calciumcarbonate (2 g) and filter agent, Celite® 541 (2 g) (available fromAldrich, Milwaukee, Wis.) were placed in a 500 mL three neck flaskfitted with a thermometer, a mechanical stirrer, and a distilling headatop a Vigreaux column. The mixture was vacuum distilled at 24 mm Hg byheating the pot to 180-225° C. Only a single fraction was collected(10.8 g) which contained a large portion of acetamide in addition to theproduct (determined by NMR). This solid product was dissolved inisopropanol (30 mL) to form the crude vinylacetamide solution used forpolymerization.

Crude vinylacetamide solution (15 mL), divinylbenzene (1 g, technicalgrade, 55% pure, mixed isomers), and AIBN (0.3 g) were mixed and heatedto reflux under a nitrogen atmosphere for 90 minutes, forming a solidprecipitate. The solution was cooled, isopropanol (50 mL) was added, andthe solid was collected by centrifugation. The solid was rinsed twice inisopropanol, once in water, and dried in a vacuum oven at about roomtemperature to yield 0.8 g of poly(vinylacetamide), which was used toprepare poly(vinylamine) as follows.

Poly(vinylacetamide) (0.79 g) was placed in a 100 mL one neck flaskcontaining water (25 mL) and conc. HCl (25 mL). The mixture was refluxedfor 5 days, after which the solid was filtered off, rinsed once inwater, twice in isopropanol, and dried in a vacuum oven to yield 0.77 gof product. Infrared spectroscopy indicated that a significant amount ofthe amide (1656 cm−1) remained and that not much amine (1606 cm−1) wasformed. The product of this reaction (˜0.84 g) was suspended in NaOH (46g) and water (46 g) and heated to boiling (˜140° C.). Due to foaming thetemperature was reduced and maintained at ˜100° C. for 2 hours. Water(100 mL) was added and the solid collected by filtration. After rinsingonce in water the solid was suspended in water (500 mL) and adjusted topH 5 with acetic acid. The solid was again filtered off, rinsed withwater, then isopropanol, and dried in a vacuum oven to yield 0.51 g ofproduct. Infrared spectroscopy indicated that significant amine had beenformed.

Example 2 Poly(allylamine) hydrochloride

To a 2 liter, water-jacketed reaction kettle equipped with (1) acondenser topped with a nitrogen gas inlet, (2) a thermometer, and (3) amechanical stirrer was added concentrated hydrochloric acid (360 mL).The acid was cooled to 5° C. using circulating water in the jacket ofthe reaction kettle (water temperature=0° C.). Allylamine (328.5 mL, 250g) was added dropwise with stirring while maintaining the reactiontemperature at 5-10° C. After addition was complete, the mixture wasremoved, placed in a 3 liter one-neck flask, and 206 g of liquid wasremoved by rotary vacuum evaporation at 60° C. Water (20 mL) was thenadded and the liquid was returned to the reaction kettle.Azobis(amidinopropane) dihydrochloride (0.5 g) was suspended in 11 mL ofwater was then added. The resulting reaction mixture was heated to 50°C. under a nitrogen atmosphere with stirring for 24 hours. Additionalazobis(amidinopropane) dihydrochloride (5 mL) suspended in 11 mL ofwater was then added, after which heating and stirring were continuedfor an additional 44 hours.

At the end of this period, distilled water (100 mL) was added to thereaction mixture and the liquid mixture allowed to cool with stirring.The mixture was then removed and placed in a 2 liter separatory funnel,after which it was added dropwise to a stirring solution of methanol (4L), causing a solid to form. The solid was removed by filtration,re-suspended in methanol (4 L), stirred for 1 hour, and collected byfiltration. The methanol rinse was then repeated one more time and thesolid dried in a vacuum oven at about room temperature to afford 215.1 gof poly(allylamine) hydrochloride as a granular white solid.

Example 3 Poly(allylamine) hydrochloride cross-linked withepichlorohydrin

To a 5 gallon vessel was added poly(allylamine) hydrochloride preparedas described in Example 2 (1 kg) and water (4 L). The mixture wasstirred to dissolve the hydrochloride and the pH was adjusted by addingsolid NaOH (284 g). The resulting solution was cooled to roomtemperature, after which epichlorohydrin cross-linking agent (50 mL) wasadded all at once with stirring. The resulting mixture was stirredgently until it gelled (about 35 minutes). The cross-linking reactionwas allowed to proceed for an additional 18 hours at room temperature,after which the polymer gel was removed and placed in portions in ablender with a total of 10 L of water. Each portion was blended gentlyfor about 3 minutes to form coarse particles which were then stirred for1 hour and collected by filtration. The solid was rinsed three times bysuspending it in water (10 L, 15 L, 20 L), stirring each suspension for1 hour, and collecting the solid each time by filtration. The resultingsolid was then rinsed once by suspending it in isopropanol (17 L),stirring the mixture for 1 hour, and then collecting the solid byfiltration, after which the solid was dried in a vacuum oven at 50° C.for 18 hours to yield about 677 g of the cross-linked polymer as agranular, brittle, white solid.

Example 4 Poly(allylamine) hydrochloride cross-linked with butanedioldiglycidyl ether

To a 5 gallon plastic bucket was added poly(allylamine) hydrochlorideprepared as described in Example 2 (500 g) and water (2 L). The mixturewas stirred to dissolve the hydrochloride and the pH was adjusted to 10by adding solid NaOH (134.6 g). The resulting solution was cooled toroom temperature in the bucket, after which 1,4-butanediol diglycidylether cross-linking agent (65 mL) was added all at once with stirring.The resulting mixture was stirred gently until it gelled (about 6minutes). The cross-linking reaction was allowed to proceed for anadditional 18 hours at room temperature, after which the polymer gel wasremoved and dried in a vacuum oven at 75° C. for 24 hours. The dry solidwas then ground and sieved to −30 mesh, after which it was suspended in6 gallons of water and stirred for 1 hour. The solid was then filteredoff and the rinse process repeated two more times. The resulting solidwas then air dried for 48 hours, followed by drying in a vacuum oven at50° C. for 24 hours to yield about 415 g of the cross-linked polymer asa white solid.

Example 5 Poly(allylamine) hydrochloride cross-linked with ethanedioldiglycidyl ether

To a 100 mL beaker was added poly(allylamine) hydrochloride prepared asdescribed in Example 2 (10 g) and water (40 mL). The mixture was stirredto dissolve the hydrochloride and the pH was adjusted to 10 by addingsolid NaOH. The resulting solution was cooled to room temperature in thebeaker, after which 1,2-ethanediol diglycidyl ether cross-linking agent(2.0 mL) was added all at once with stirring. The resulting mixture wasstirred gently until it gelled (about 4 minutes). The cross-linkingreaction was allowed to proceed for an additional 18 hours at roomtemperature, after which the polymer gel was removed and blended in 500mL of methanol. The solid was then filtered off and suspended in water(500 mL). After stirring for 1 hour, the solid was filtered off and therinse process repeated. The resulting solid was rinsed twice inisopropanol (400 mL) and then dried in a vacuum oven at 50° C. for 24hours to yield

8.7 g of the cross-linked polymer as a white solid.

Example 6 Poly(allylamine) hydrochloride cross-linked withdimethylsuccinate

To a 500 mL round bottom flask was added poly(allylamine) hydrochlorideprepared as described in Example 2 (10 g), methanol (100 mL), andtriethylamine (10 mL). The mixture was stirred and dimethylsuccinatecross-linking agent (1 mL) was added. The solution was heated to refluxand the stirring discontinued after 30 minutes. After 18 hours, thesolution was cooled to room temperature, and the solid filtered off andblended in 400 mL of isopropanol. The solid was then filtered off andsuspended in water (1 L). After stirring for 1 hour, the solid wasfiltered off and the rinse process repeated two more times. The solidwas then rinsed once in isopropanol (800 mL) and dried in a vacuum ovenat 50° C. for 24 hours to yield 5.9 g of the cross-linked polymer as awhite solid.

Example 7 Poly(allyltrimethylammonium chloride)

To a 500 mL three-necked flask equipped with a magnetic stirrer, athermometer, and a condenser topped with a nitrogen inlet, was addedpoly(allylamine) cross-linked with epichlorohydrin (5.0 g), methanol(300 mL), methyl iodide (20 mL), and sodium carbonate (50 g). Themixture was then cooled and water was added to total volume of 2 L.Concentrated hydrochloric acid was added until no further bubblingresulted and the remaining solid was filtered off. The solid was rinsedtwice in 10% aqueous NaCl (1 L) by stirring for 1 hour followed byfiltration to recover the solid. The solid was then rinsed three timesby suspending it in water (2 L), stirring for 1 hour, and filtering torecover the solid. Finally, the solid was rinsed as above in methanoland dried in a vacuum over at 50° C. for 18 hours to yield 7.7 g ofwhite granular solid.

Example 8 Poly(ethyleneimine)/acryloyl chloride

Into a 5 L three-neck flask equipped with a mechanical stirrer, athermometer, and an additional funnel was added polyethyleneimine (510 gof a 50% aqueous solution (equivalent to 255 g of dry polymer) andisopropanol (2.5 L). Acryloyl chloride (50 g) was added dropwise throughthe addition funnel over a 35 minute period, keeping the temperaturebelow 29° C. The solution was then heated to 60° C. with stirring for 18hours. The solution was cooled and solid immediately filtered off. Thesolid was rinsed three times by suspending it in water (2 gallons),stirring for 1 hour, and filtering to recover the solid. The solid wasrinsed once by suspending it in methanol (2 gallons), stirring for 30minutes, and filtering to recover the solid. Finally, the solid wasrinsed as above in isopropanol and dried in a vacuum over at 50° C. for18 hours to yield 206 g of light orange granular solid.

Example 9 Poly(dimethylaminopropylacrylamide)

Dimethylamino-propylacrylamide (10 g) and methylene-bisacrylamide (1.1g) were dissolved in 50 mL of water in a 100 mL three-neck flask. Thesolution was stirred under nitrogen for 10 minutes. Potassium persulfate(0.3 g) and sodium metabisulfite (0.3 g) were each dissolved in 2-3 mLof water and then mixed. After a few seconds this solution was added tothe monomer solution, still under nitrogen. A gel formed immediately andwas allowed to sit overnight. The gel was removed and blended with 500mL of isopropanol. The solid was filtered off and rinsed three timeswith acetone. The solid white powder was filtered off and dried in avacuum oven at about room temperature to yield 6.1 g.

Example 10 Poly(Methacrylamidopropyltrimethylammoniumchloride)=(Poly(MAPTAC))

(3-(Methacryloylamino)propyl)trimethylammonium chloride (38 mL of 50%aqueous solution) and methylenebis-methacrylamide (2.2 g) were stirredin a beaker at room temperature. Methanol (10 mL) was added and thesolution was warmed to 40° C. to fully dissolve the bisacrylamide.Potassium persulfate (0.4 g) was added and the solution stirred for 2minutes. Potassium metabisulfite (0.4 g) was added and stirring wascontinued. After 5 minutes the solution was put under a nitrogenatmosphere. After 20 minutes the solution contained significantprecipitate and the solution was allowed to sit overnight. The solid waswashed three times with isopropanol and collected by filtration. Thesolid was then suspended in water 500 (mL) and stirred for several hoursbefore being collected by centrifugation. The solid was again washedwith water and collected by filtration. The solid was then dried in avacuum oven at about room temperature to yield 21.96 g.

Example 11 Poly(ethyleneimine) “A”

Polyethyleneimine (50 g of a 50% aqueous solution; Scientific PolymerProducts) was dissolved in water (100 mL). Epichlorohydrin (4.6 mL) wasadded dropwise. The solution was heated to 55° C. for 4 hours, afterwhich it had gelled. The gel was removed, blended with water (1 L) andthe solid was filtered off. It was resuspended in water (2 L) andstirred for 10 minutes. The solid was filtered off, the rinse repeatedonce with water and twice with isopropanol, and the resulting gel wasdried in a vacuum oven at about room temperature to yield 26.3 g of arubbery solid.

Poly(ethyleneimine) “B” and Poly(ethyleneimine) “C” were made in asimilar manner, except using 9.2 and 2.3 mL of epichlorohydrin,respectively.

Example 12 Poly(methylmethacrylate-co-divinylbenzene)

Methylmethacrylate (50 g) and divinylbenzene (5 g) andazobisiso-butyronitrile (1.0 g) were dissolved in isopropanol (500 mL)and heated to reflux for 18 hours under a nitrogen 14 atmosphere. Thesolid white precipitate was filtered off, rinsed once in acetone(collected by centrifugation), once in water (collected by filtration)and dried in a vacuum oven at about room temperature to yield 19.4 g.

Example 13 Poly(diethylenetriaminemethacrylamide)

Poly(methyl-methacrylate-co-divinylbenzene) (20 g) was suspended indiethylenetriamine (200 mL) and heated to reflux under a nitrogenatmosphere for 18 hours. The solid was collected by filtration,resuspended in water (500 mL), stirred 30 minutes, filtered off,resuspended in water (500 mL), stirred 30 minutes, filtered off, rinsedbriefly in isopropanol, and dried in a vacuum oven at about roomtemperature to yield 18.0 g.

Poly(pentaethylenehexaminemethacrylamide),Poly(tetraethylenepentamine-methacrylamide), andPoly(triethylenetetraaminemethacrylamide) were made in a manner similarto poly(diethylenetriaminemethacrylamide) from pentaethylene-hexamine,tetraethylenepentamine, and triethylenetetraamine, respectively.

Example 14 Poly(methylmethacrylate/PEI)

Poly(methylmethacrylate-co-divinylbenzene) (1.0 g) was added to amixture containing hexanol (9150 mL) and polyethyleneimine (15 g in 15 gwater). The mixture was heated to reflux under nitrogen for 4 days. Thereaction was cooled and the solid was filtered off, suspended inmethanol (300 mL), stirred 1 hour, and filtered off. The rinse wasrepeated once with isopropanol and the solid was dried in a vacuum ovenat about room temperature to yield 0.71 g.

Example 15 Poly(aminoethylmethacrylamide)

Poly(methylmethacrylate-co-divinylbenzene) (20 g) was suspended inethylenediamine 9200 mL) and heated to reflux under a nitrogenatmosphere for 3 days. The solid was collected by centrifugation, washedby resuspending it in water (500 mL), stirring for 30 minutes, andfiltering off the solid. The solid was washed twice more in water, oncein isopropanol, and dried in a vacuum oven at about room temperature toyield 17.3 g.

Example 16 Poly(diethylaminopropylmethacrylamide)

Poly(methyl-methacrylate-co-divinylbenzene) (20 g) was suspended indiethylaminopropylamine (200 mL) and heated to reflux under a nitrogenatmosphere for 18 hours. The solid was collected by filtration,resuspended in water (500 mL), filtered off, resuspended in water (500mL), collected by filtration, rinsed briefly in isopropanol, and driedin a vacuum oven at about room temperature to yield 8.2 g.

Example 17 NHS-acrylate

N-Hydroxysuccinimide (NHS, 157.5 g) was dissolved in chloroform (2300mL) in a 5 L flask. The solution was cooled to 0° C. and acryloylchloride (132 g) was added dropwise, keeping the temperature at 2° C.After addition was complete, the solution was stirred for 1.5 hours,rinsed with water (1100 mL) in a separatory funnel and dried overanhydrous sodium sulfate. The solvent was removed under vacuum, and asmall amount of ethyl acetate was added to the residue. This mixture waspoured into hexane (200 mL) with stirring. The solution was heated toreflux, adding more ethyl acetate (400 mL). The insoluble NHS wasfiltered off, hexane (1 L) was added, the solution was heated to reflux,ethyl acetate (400 mL) was added, and the solution allowed to cool to<10° C. The solid was then filtered off and dried in a vacuum oven atabout room temperature to yield 125.9 g. A second crop of 80 g wassubsequently collected by further cooling.

Example 18 Poly(NHS-acrylate)

NHS-acrylate (28.5 g), methylenebis-acrylamide (1.5 g) andtetrahydrofuran (500 mL) were mixed in a 1 L flask and heated to 50° C.under a nitrogen atmosphere. Azobisisobutyronitrile (0.2 g) was added,the solution was stirred for 1 hour, filtered to remove excessN-hydroxysuccinimide, and heated to 50° C. for 4.5 hours under anitrogen atmosphere. The solution was then cooled and the solid wasfiltered off, rinsed in tetrahydrofuran, and dried in a vacuum oven atabout room temperature to yield 16.1 g.

Example 19 Poly(guanidinobutylacrylamide)

Poly(NHS-acrylate) (1.5 g) was suspended in water (25 mL) containingagmatine (1.5 g) which had been adjusted to pH 9 with solid NaOH. Thesolution was stirred for 4 days, after which time the pH had dropped to6.3. Water was added to a total of 500 mL, the solution was stirred for30 minutes and the solid was filtered off. The solid was rinsed twice inwater, twice in isopropanol, and dried in a vacuum oven at about roomtemperature to yield 0.45 g.

Example 20 Poly(methacryloyl chloride)

Methacryloyl chloride (20 mL), divinyl benzene (4 mL of 80% purity),AIBN (0.4 g), and THF (150 mL) were stirred at 60° C. under a nitrogenatmosphere for 18 hours. The solution was cooled and the solid wasfiltered off, rinsed in THF, then acetone, and dried in a vacuum oven atabout room temperature to yield 8.1 g.

Example 21 Poly(guanidinobutylmethacrylamide)

Poly(methacryloyl chloride) (0.5 g), agmatine sulfate (1.0 g),triethylamine (2.5 mL), and acetone (50 mL) were stirred together for 4days. Water (100 mL) was added and the mixture stirred for 6 hours. Thesolid was filtered off and washed by resuspending in water (500 mL),stirring for 30 minutes, and filtering off the solid. The wash wasrepeated twice in water, once in methanol, and the solid was dried in avacuum oven at about room temperature to yield 0.41 g.

Example 22 Poly(guanidinoacrylamide)

The procedure for poly-(guanidinobutylacrylamide) was followedsubstituting aminoguanidine bicarbonate (5.0 g) for the agmatinesulfate, yielding 0.75 g.

Example 23 Poly(PEH/EPI)

Epichlorohydrin (1.5 g) was added dropwise to a solution containingpentaethylenehexamine (PEH) (20 g) and water (100 mL), keeping thetemperature at 65° C. The solution was stirred until it gelled andheating was continued for 4 hours (at 65° C.). After sitting overnightat room temperature the gel was removed and blended with water (1 L).The solid was filtered off, water was added (1 L), and the blending andfiltration were repeated. The gel was suspended in isopropanol and theresulting solid was collected by filtration and dried in a vacuum ovenat about room temperature to yield 28.2 g.

Example 24 Ethylidenebisacetamide

Acetamide (118 g), acetaldehyde (44.06 g), glucose acetate (0.2 g), andwater (300 mL) were placed in a 1 L three-neck flask fitted withcondenser, thermometer, and mechanical stirred. Concentrated HCl (34 mL)was added and the mixture was heated to 45-50° C. with stirring for 24hours. The water was then removed in vacuo to leave a thick sludge whichformed crystals on cooling to 5° C. Acetone (200 mL) was added andstirred for a few minutes after which the solid was filtered off anddiscarded. The acetone was cooled to 0° C. and solid was filtered off.This solid was rinsed in 500 mL acetone and air dried 18 hours at aboutroom temperature to yield 31.5 g.

Example 25 Vinylacetamide

Ethylidenebisacetamide (31.05), calcium carbonate (2 g) and Celite 541®(2 g) were placed in a 500 mL three-neck flask fitted with athermometer, a mechanical stirrer, and a distilling head atop a Vigreauxcolumn. The mixture was vacuum distilled at 35 mm Hg by heating the potto 180-225° C. Only a single fraction was collected (10.8 g) whichcontained a large portion of acetamide in addition to the product(determined by NMR). This solid product was dissolved in isopropanol (30mL) to form the crude solution used for polymerization.

Example 26 Poly(vinylacetamide)

Crude vinylacetamide solution (15 mL), divinylbenzene (1 g, technicalgrade, 55% pure, mixed isomers), and AIBN (0.3 g) were mixed and heatedto reflux under a nitrogen atmosphere for 90 minutes, forming a solidprecipitate. The solution was cooled, isopropanol (50 mL) was added, andthe solid was collected by centrifugation. The solid was rinsed twice inisopropanol, once in water, and dried in a vacuum oven at about roomtemperature to yield 0.8 g.

Example 27 Poly(vinylamine)

Poly(vinylacetamide) (0.79 g) was placed in a 100 mL one neck flaskcontaining water 25 mL and concentrated HCl 25 mL. The mixture wasrefluxed for 5 days, the solid was filtered off, rinsed once in water,twice in isopropanol, and dried in a vacuum oven to yield 0.77 g. Theproduct of this reaction (˜0.84 g) was suspended in NaOH (46 g) andwater (46 g) and heated to boiling (˜140° C.). Due to foaming, thetemperature was reduced and maintained at ˜100° C. for 2 hours. Water(100 mL) was added and the solid collected by filtration. After rinsingonce in water, the solid was suspended in water (500 mL) and adjusted topH 5 with acetic acid. The solid was again filtered off, rinsed withwater, then the isopropanol, and dried in a vacuum oven at about roomtemperature to yield 0.51 g.

Example 28 Poly(ethyleneimine) Salts

Polyethyleneimine (25 g dissolved in 25 g water) was dissolved in water(100 mL) and mixed with toluene (1 L). Epichlorohydrin (2.3 mL) wasadded and the mixture heated to 60° C. with vigorous mechanical stirringfor 18 hours. The mixture was cooled and the solid filtered off,resuspended in methanol (2 L), stirred 1 hour, and collected bycentrifugation. The solid was suspended in water (2 L), stirred 1 hour,filtered off, suspended in water (4 L), stirred 1 hour, and againfiltered off. The solid was suspended in acetone (4 L) and stirred 15minutes, the liquid was poured off, acetone (2 L) was added, the mixturewas stirred 15 minutes, the acetone was again poured off, and the solidwas dried in a vacuum oven at about room temperature to formintermediate “D”.

Example 29 Poly(ethyleneimine sulfate A)

Intermediate “D” (1.0 g) was suspended in water (150 mL), stirred 30minutes, and partially neutralized with sulfuric acid (1.1 g). Themixture was stirred an additional 30 minutes, the solid was filteredoff, resuspended in methanol (200 mL), stirred 5 minutes, filtered off,and dried in a vacuum oven at about room temperature.

Example 30 Poly(ethyleneimine sulfate B)

Intermediate “D” (1.0 g) was suspended in water (150 mL), stirred 30minutes, and partially neutralized with sulfuric acid (0.57 g). Themixture was stirred an additional 30 minutes, the solid was filteredoff, resuspended in methanol (200 mL), stirred 5 minutes, filtered off,and dried in a vacuum oven at about room temperature.

Example 31 Poly(ethyleneimine sulfate C)

Intermediate “D” (1.0 g) was suspended in water (150 mL), stirred 30minutes, and partially neutralized with sulfuric acid (0.28 g). Themixture was stirred an additional 30 minutes, the solid was filteredoff, resuspended in methanol (200 mL), stirred 5 minutes, filtered off,and dried in a vacuum oven at about room temperature.

Example 32 Poly(ethyleneimine sulfate D)

Intermediate “D” (1.0 g) was suspended in water (150 mL), stirred 30minutes, and partially neutralized with sulfuric acid (0.11 g). Themixture was stirred an additional 30 minutes, the solid was filteredoff, resuspended in methanol (200 mL), stirred 5 minutes, filtered off,and dried in a vacuum oven at about room temperature.

Example 33 Poly(ethyleneimine tartrate A)

Intermediate “D” (1.0 g) was suspended in water (150 mL), stirred 30minutes, and partially neutralized with tartaric acid (1.72 g). Themixture was stirred an additional 30 minutes, the solid was filteredoff, resuspended in methanol (200 mL), stirred 5 minutes, filtered off,and dried in a vacuum oven at about room temperature.

Example 34 Poly(ethyleneimine tartrate B)

Intermediate “D” (1.0 g) was suspended in water (150 mL), stirred 30minutes, and partially neutralized with tartaric acid (0.86 g). Themixture was stirred an additional 30 minutes, the solid was filteredoff, resuspended in methanol (200 mL), stirred 5 minutes, filtered off,and dried in a vacuum oven at about room temperature.

Example 35 Poly(ethyleneimine tartrate C)

Intermediate “D” (1.0 g) was suspended in water (150 mL), stirred 30minutes, and partially neutralized with tartaric acid (0.43 g). Themixture was stirred an additional 30 minutes, the solid was filteredoff, resuspended in methanol (200 mL), stirred 5 minutes, filtered off,and dried in a vacuum oven at about room temperature.

Example 36 Poly(ethyleneimine ascorbate A)

Intermediate “D” (1.0 g) was suspended in water (150 mL), stirred 30minutes, and partially neutralized with ascorbic acid (4.05 g). Themixture was stirred an additional 30 minutes, the solid was filteredoff, resuspended in methanol (200 mL), stirred 5 minutes, filtered off,and dried in a vacuum oven at about room temperature.

Example 37 Poly(ethyleneimine ascorbate B)

Intermediate “D” (1.0 g) was suspended in water (150 mL), stirred 30minutes, and partially neutralized with ascorbic acid (2.02 g). Themixture was stirred an additional 30 minutes, the solid was filteredoff, resuspended in methanol (200 mL), stirred 5 minutes, filtered off,and dried in a vacuum oven at about room temperature.

Example 38 Poly(ethyleneimine ascorbate C)

Intermediate “D” (1.0 g) was suspended in water (150 mL), stirred 30minutes, and partially neutralized with ascorbic acid (1.01 g). Themixture was stirred an additional 30 minutes, the solid was filteredoff, resuspended in methanol (200 mL), stirred 5 minutes, filtered off,and dried in a vacuum oven at about room temperature.

Example 39 Poly(ethyleneimine citrate A)

Intermediate “D” (1.0 g) was suspended in water (150 mL), stirred 30minutes, and partially neutralized with citric acid (1.47 g). Themixture was stirred an additional 30 minutes, the solid was filteredoff, resuspended in methanol (200 mL), stirred 5 minutes, filtered off,and dried in a vacuum oven at about room temperature.

Example 40 Poly(ethyleneimine citrate B)

Intermediate “D” (1.0 g) was suspended in water (150 mL), stirred 30minutes, and partially neutralized with citric acid (0.74 g). Themixture was stirred an additional 30 minutes, the solid was filteredoff, resuspended in methanol (200 mL), stirred 5 minutes, filtered off,and dried in a vacuum oven at about room temperature.

Example 41 Poly(ethyleneimine citrate C)

Intermediate “D” (1.0 g) was suspended in water (150 mL), stirred 30minutes, and partially neutralized with citric acid (0.37 g). Themixture was stirred an additional 30 minutes, the solid was filteredoff, resuspended in methanol (200 mL), stirred 5 minutes, filtered off,and dried in a vacuum oven at about room temperature.

Example 42 Poly(ethyleneimine succinate A)

Intermediate “D” (1.0 g) was suspended in water (150 mL), stirred 30minutes, and partially neutralized with succinic acid (1.36 g). Themixture was stirred an additional 30 minutes, the solid was filteredoff, resuspended in methanol (200 mL), stirred 5 minutes, filtered off,and dried in a vacuum oven at about room temperature.

Example 43 Poly(ethyleneimine succinate B)

Intermediate “D” (1.0 g) was suspended in water (150 mL), stirred 30minutes, and partially neutralized with succinic acid (0.68 g). Themixture was stirred an additional 30 minutes, the solid was filteredoff, resuspended in methanol (200 mL), stirred 5 minutes, filtered off,and dried in a vacuum oven at about room temperature.

Example 44 Poly(ethyleneimine chloride)

Polyethyleneimine (100 g in 100 g water) was dissolved in water (640 mLadditional) and the pH was adjusted to 10 with concentrated HCl.Isopropanol (1.6 L) was added, followed by epichlorohydrin (19.2 mL).The mixture was stirred under nitrogen for 18 hours at 60° C. The solidswere filtered off and rinsed with methanol (300 mL) on the funnel. Thesolid was rinsed by resuspending it in methanol (4 L), stirring 30minutes, and filtering off the solid. The rinse was repeated twice withmethanol, followed by resuspension in water (1 gallon). The pH wasadjusted to

1.0 with concentrated HCl, the solid was filtered off, resuspended inwater (1 gallon), the pH again adjusted to 1.0 with concentrated HCl,the mixture stirred 30 minutes, and the solid filtered off. The methanolrinse was again repeated and the solid dried in a vacuum oven at aboutroom temperature to yield 112.4 g.

Example 45 Poly(dimethylethyleneimine chloride)

Poly(ethyleneimine chloride) (5.0 g) was suspended in methanol (300 mL)and sodium carbonate (50 g) was added. Methyl iodide (20 mL) was addedand the mixture heated to reflux for 3 days. Water was added to reach atotal volume of 500 mL, the mixture stirred for 15 minutes, and thesolid filtered off. The solid was suspended in water (500 mL), stirred30 minutes, and filtered. The solid was suspended in water

(1 L), the pH adjusted to 7.0 with concentrated HCl, and the mixturestirred for 10 minutes. The solid was filtered off, resuspended inisopropanol (1 L), stirred 30 minutes, filtered off, and dried in avacuum oven at about room temperature to yield 6.33 g.

Example 46 Poly(methacryloyl chloride)

Methacryloyl chloride (20 mL), divinyl benzene (4 mL of 80% purity),AIBN (0.4 g), and THF (150 mL) were stirred at 60° C. under a nitrogenatmosphere for 18 hours. The solution was cooled, and the solid wasfiltered off, rinsed in THF, then acetone, and dried in a vacuum oven atabout room temperature to yield 8.1 g.

Example 47 Poly(guanidinobutylmethacrylamide)

Poly(methacryloyl chloride) (0.5 g), agmatine sulfate (1.0 g),triethylamine (2.5 mL), and acetone (50 mL) were stirred together for 4days. Water (100 mL) was added, and the mixture stirred for 6 hours. Thesolid was filtered off, washed by resuspending in water (500 mL),stirring for 30 minutes, and filtering off the solid. The wash wasrepeated twice in water, once in methanol, and the solid was dried in avacuum oven at about room temperature to yield 0.41 g.

Example 48 Poly(PEH/EPI)

Epichlorohydrin (21.5 g) was added dropwise to a solution containingpentaethylenehexamine (20 g) and water (100 mL), keeping the temperaturebelow 65° C. The solution was stirred until it gelled, and heating wascontinued for 4 hours (at 65° C.). After sitting overnight at roomtemperature, the gel was removed and blended with water (1 L). The solidwas filtered off, water was added (1 L), and the blending and filtrationwere repeated. The gel was suspended in isopropanol, and the resultingsolid was collected by filtration and dried in a vacuum oven at aboutroom temperature to yield 28.2 g.

Example 49 Poly(TAEA-acrylamide)

Poly(NHS-acrylate) (4.4 g) was suspended in a solution containing water(100 mL) and tris(2-aminoethyl)amine (30 mL) which had been adjusted topH 9 with concentrated HCl. After 4 days of stirring, the solid wasfiltered off, and the wash repeated. The solid was then rinsed brieflywith water twice, isopropanol once, and dried in a vacuum oven at aboutroom temperature to yield 3.4 g.

Example 50 Poly(PEH-acrylamide)

Poly(NHS-acrylate) (5.0 g) was suspended in a solution containing water(100 mL) and pentaethylene hexamine (30 mL) which had been adjusted topH 10 with concentrated HCl. After 4 days of stirring, the solid wasfiltered off and resuspended in water (500 mL). The mixture was stirredfor 4 hours, the solid was filtered off, and the wash repeated. Thesolid was then rinsed briefly with water twice, isopropanol once, anddried in a vacuum oven at about room temperature to yield 4.7 g.

Example 51 Poly(MI/EPI)

To a 500 mL flask was added 2-methylimidazole (41.00 g, 0.50 mol) andwater (100 mL). The solution was heated to 55° C., and epichlorohydrin(46.3 g. 0.50 mol) was added dropwise over 100 minutes. The maximumtemperature reached during the addition was 75° C. When the addition wascomplete, the solution was heated to 90° C. and held at that temperaturefor 18 hours. In the morning, the reaction was cooled to 45° C., andepichlorohydrin (8.7 g, 0.094 mol) was added dropwise. After theaddition was complete, the solution was stirred at 45° C. for 2 hours.At this point, a solution of sodium hydroxide (3.78 g, 0.094 mol) inwater (15 mL) was prepared. The reaction was cooled, and the sodiumhydroxide solution was added dropwise at 28° C. over 10 minutes. Thesolution was stirred for an additional 15 minutes and then transferredto a beaker and heated to 95° C. on a hot plate. When the reactionsolidified, it was placed in an oven at 125° C. for 5 hours to cure.After cooling to room temperature, the polymer was broken up and addedto 2000 mL of water. The mixture was allowed to stand for 3 hours andthen blended in two portions. The hydrated gel was filtered and thendehydrated with isopropanol in two steps in the blender. Filtration andvacuum drying at about room temperature afforded 83.51 g of titlepolymer.

Example 52 Polyallylamine cross-linked with epichlorohydrin

An aqueous solution of poly(allylamine hydrochloride) (500 lb of a 50.7%aqueous solution) was diluted with water (751 lb) and neutralized withaqueous sodium hydroxide (171 lb of a 50% aqueous solution). Thesolution was cooled to approximately 25° C., and acetonitrile (1340 lb)and epichlorohydrin (26.2 lb) were added. The solution was stirredvigorously for 21 hours. During this time, the reactor contents changedfrom two liquid phases to a slurry of particles in a liquid. The solidgel product was isolated by filtration. The gel was washed in anelutriation process with water (136,708 lb). The gel was isolated byfiltration and rinsed with isopropanol. The gel was slurried withisopropanol (1269 lb) and isolated by filtration. The isopropanol/waterwet gel was dried in a vacuum dryer at 60° C. The dried product wasground to pass through a 50 mesh screen to give a product suitable forpharmacologic use (166 lb, 73%).

Clinical Studies I: Observations with Renagel® (Geltex Pharmaceuticals.Inc., Waltham, Mass.)

Serum Glucose was measured as a safety laboratory in haemodialysisclinical studies, Protocols 1-6, in patients with diabetes as theprimary cause of renal failure. None of the glucose measurements werefasting measurements. A description of each of clinical Protocols 1-6may be found in the following references, the teachings of which areincorporated herein by reference in their entireties:

Protocol 1:

Chertow, G. M., Burke, S. K., Lazarus, J. M., Stenzel, K. H., Wombolt,D., Goldberg, D., Bonventre, J. V., and Slatopolsky, E.,“Poly(allylamine hydrochloride) (RenaGel®): a noncalcemic phosphatebinder for the treatment of hyperphosphatemia in chronic renal failure,”Am J Kid Dis. 29: 66-71 (1997).

Protocol 2:

Goldberg, D. I., Dillon, M. A., Slatapolsky, E. A., Garrett, B., Gray,J. R., Marbury, T., Weinberg, M., Wombolt, D., and Burke, S. K., “Effectof RenaGel, a non-absorbed, calcium- and aluminum-free phosphate binder,on serum phosphorus, calcium, and intact parathyroid hormone inend-stage renal disease patients,” Nephrol Dial Transplant. 13:2303-2310 (1998).

Protocol 3:

Chertow, G. M., Dillon, M., Burke, S. K., Steg, M., Bleyer, A. J.,Garrett, B. N., Domoto, D. T., Wilkes, B. M., Wombolt, D. G., andSlatopolsky, E., “A randomized trial of sevelamer hydrochloride(RenaGel®) with and without supplemental calcium. Strategies for thecontrol of hyperphosphatemia in hemodialysis patients,” Clin Nephrol.51: 18-26 (1999).

Protocol 4:

Bleyer, A. J., Burke, S. K., Dillon, M., Garrett, B., Kant, K. S.,Lynch, D., Raman, S. N., Shoenfeld, P., Teitelbaum, I., Zieg, S., andSlatopolsky, E., “A comparison of the calcium-free phosphate bindersevelamer hydrochloride with calcium acetate in the treatment ofhyperphosphatemia in hemodialysis patients,” Am J Kid Dis. 33: 694-701(1999).

Protocol 5:

Slatopolsky, E., Burke, S. K., Dillon, M. A., and the Renagel StudyGroup, “RenaGel®, a nonabsorbed calcium- and aluminum-free phosphatebinder, lowers serum phosphorus and parathyroid hormone,” Kid Int. 55:299-307 (1999).

Protocol 6:

Chertow, G. M., Burke, S. K., Dillon, M. A., and Slatopolsky, E., forthe Renagel Study Group, “Long-term effects of sevelamer hydrochlorideon the calcium×phosphorus product and lipid profile of haemodialysispatients,” Nephol Dial Transplant. 14: 2907-2914 (1999).

Decreases in serum glucose from baseline to the end of the study wereseen in each of the haemodialysis clinical studies (Table 1) except theclinical study of protocol 3. TABLE 1 Baseline Protocol mg/dL EndpointChange P-Value 1 179.50 130.39 −37.9 0.0984 2 135.1 132.6 −2.8 0.7903 3146.9 154.6 18.4 0.9063 4 135.3 128.7 −6.7 0.1327 5 127.1 121.5 −3.70.3203 6 135.1 235.4 −9.7 0.1405Clinical Studies II: Observations with Colesevelam

Glucose was measured as a safety laboratory at weeks −4, 0, 12 and 24.There was a significant group effect for serum glucose (p=0.03) forchange from day 0 to 168 for all patients. Decreases from day 0 to 168of 2.8 and 2.2 mg/dL in the 3.8 and 4.5 g/d groups were statisticallysignificant (p<0.01).

Cholestyramine (8 g/d, bid) improved glycemic control in patients withType II diabetes, possibly related to changes in glucose absorption. Inthe pivotal trial, plasma glucose decreased in the two high dosecolesevelam groups. In a post hoc analysis of patients with diabetes(n=13), serum glucose fell from 140 mg/dL on diet alone to 122 mg/dL oncolesevelam 3.8 or 4.5 g/d (p<0.01). Similar effects were seen in ananalysis of the integrated safety data. Confirmatory studies that couldbe done inexpensively on stored sera (from drug interaction studies)include (1) measurements of HgbA1c in the pivotal 24 week trial; and (2)measurements of glucose and insulin response to a standard meal with orwithout colesevelam.

EQUIVALENTS

It should be understood, however, that the foregoing description of theinvention is intended merely to be illustrative by way of example onlyand that other modifications, embodiments, and equivalents may beapparent to those skilled in the art without departing from its spirit.

While this invention has been particularly shown and described withreferences to preferred embodiments thereof, it will be understood bythose skilled in the art that various changes in form and details may bemade therein without departing from the scope of the inventionencompassed by the appended claims.

While this invention has been particularly shown and described withreferences to example embodiments thereof, it will be understood bythose skilled in the art that various changes in form and details may bemade therein without departing from the scope of the inventionencompassed by the appended claims.

1-20. (canceled)
 21. A method for reducing serum glucose levels in ahuman diabetic patient, comprising administering to said patient atherapeutically effective amount of a powder comprising colesevelam or apharmaceutically acceptable salt thereof.
 22. The method of claim 21,wherein the powder comprises a pharmaceutically acceptable salt ofcolesevelam.
 23. The method of claim 21, wherein the powder isadministered to the patient by incorporating it into a drink.
 24. Themethod of claim 22, wherein the powder is administered to the patient byincorporating it into a drink.
 25. A method for reducing serum glucoselevels in a human diabetic patient, comprising administering to saidpatient a therapeutically effective amount of a powder comprisingcolesevelam or a pharmaceutically acceptable salt thereof, wherein saidcolesevelam or pharmaceutically acceptable salt thereof is the onlyactive ingredient administered to the patient.
 26. The method of claim25, wherein the powder comprises a pharmaceutically acceptable salt ofcolesevelam.
 27. The method of claim 25, wherein the powder isadministered to the patient by incorporating it into a drink.
 28. Themethod of claim 26, wherein the powder is administered to the patient byincorporating it into a drink.